Blockage Where Tubes Join Uterus

Blockage Where Tubes Join Uterus

In your experience, how much does it improve a woman's chances for pregnancy if she has both of her fallopian tubes unblocked at the junction of the uterus? There are no other problems. The doctor said that the blockage was due to dried mucus and debris accumulated over time. She said that my tubes look healthy from the outside and the inside. Jennifer

Proximal tubal obstruction (PTO) is often diagnosed when a hysterosalpingogram (HSG) is performed to check the condition of the fallopian tubes. The HSG, an X-ray procedure, tracks movement of a fluid through the uterus and fallopian tubes to see whether the passage through the tube is clear, meaning the egg has a clear path to the uterus. An obstruction that occurs where the tube joins the uterus is called proximal obstruction.

Whether blockage is actually the problem is another issue you should discuss with a fertility specialist. If you have a lot of pain during the HSG, you may be experiencing spasm of the tubal ostium (opening), which can falsely suggest there is a tubal problem. As spasm is not really tubal blockage, this finding would not be a cause for infertility. If the HSG is performed too late in your cycle, after about day 10 (counting the first day of your period as day 1), the obstruction may be the result of a thickened uterine lining that is temporarily blocking the tubal opening. In some cases, dried mucus or debris consisting of dead cells from the uterine lining may indeed be blocking the opening.

A handful of studies have shown that the process of the HSG test itself may sometimes help unclog this sort of blockage and enhance fertility. A more direct treatment of PTO involves passing a thin wire through the cervix and uterus and into the tube to dislodge the debris. This procedure, called fallopian tube recanalization, can be done as an outpatient procedure either in the radiology department or in the operating room using laparoscopy (a surgical approach that involves inserting miniature instruments through tiny slits in the abdomen). Often surgeons prefer the latter procedure because the tubes may be blocked at both ends, and laparoscopy can help us check out both ends.

If the tube appears blocked both at the uterus and at the ovarian end, repair is futile and in vitro fertilization (IVF) would be the more appropriate fertility approach. If we find that the ovarian end of the fallopian tube is normal, then we can proceed to try to open the uterine end. A recanalization procedure opens at least one tube in up to 85 percent of patients. About one-third of those patients go on to conceive. If a patient does not become pregnant in six months, she should have another HSG, as sometimes a previously blocked tube becomes blocked again.

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